Abstract
Simple SummaryBreast cancers that lack expression of the predictive markers oestrogen receptor, progesterone receptor and human epidermal growth factor receptor-2 are known as triple-negative breast cancers (TNBCs) and are generally considered to have a poor prognosis. As available targeted treatments are not effective, aggressive chemotherapy is frequently advocated for patients with TNBC. It is now becoming apparent that TNBC is not one entity but constitutes a range of malignancies with different clinical behaviour. This paper reviews 7 distinct histological subtypes of TNBC where the overall prognosis is favourable, and aggressive systemic treatment is generally not indicated. Their recognition and separation from the larger group of no special type TNBC are important. The members of the European Working Group for Breast Screening Pathology review the morphology, known molecular features and reported outcomes, and formulate a consensus statement regarding the approach to the subtypes that are associated with a favourable prognosis.Triple-negative breast cancers (TNBC), as a group of tumours, have a worse prognosis than stage-matched non-TNBC and lack the benefits of routinely available targeted therapy. However, TNBC is a heterogeneous group of neoplasms, which includes some special type carcinomas with a relatively indolent course. This review on behalf of the European Working Group for Breast Screening Pathology reviews the literature on the special histological types of BC that are reported to have a triple negative phenotype and indolent behaviour. These include adenoid cystic carcinoma of classical type, low-grade adenosquamous carcinoma, fibromatosis-like metaplastic carcinoma, low-grade mucoepidermoid carcinoma, secretory carcinoma, acinic cell carcinoma, and tall cell carcinoma with reversed polarity. The pathological and known molecular features as well as clinical data including treatment and prognosis of these special TNBC subtypes are summarised and it is concluded that many patients with these rare TNBC pure subtypes are unlikely to benefit from systemic chemotherapy. A consensus statement of the working group relating to the multidisciplinary approach and treatment of these rare tumour types concludes the review.
Highlights
Our understanding of the biology of human breast cancer (BC) has evolved exponentially since the first documented written reference to BC in the Edwin Smith papyrus in 3000 B.C. and ancient Greek times when Hippocrates perceived the disease as a single mortal one [1]
No molecular classification of Triple-negative breast cancers (TNBC) is used in daily practice to formulate prognosis and to assist clinical management recommendations
On behalf of the EWGBSP, we have provided evidence that histological examination can identify subtypes of TNBC that are associated with a favourable prognosis
Summary
Our understanding of the biology of human breast cancer (BC) has evolved exponentially since the first documented written reference to BC in the Edwin Smith papyrus in 3000 B.C. and ancient Greek times when Hippocrates perceived the disease as a single mortal one [1]. It is our view that the metastatic events reported in the literature for cases of FLMC likely reflect the inclusion of tumours with a high-grade spindle cell component (MBC). Low-grade adenosquamous carcinoma (LGASC) of the breast is a rare variant of MBC with a favourable outcome These tumours are composed of well-developed glandular and tubular formations intimately admixed with solid nests of squamous cells arranged in a haphazard, infiltrative pattern in a spindle cell background, typically associated with a peripheral lymphocytic infiltrate (Figure 1D) [11]. LGASC should be distinguished from other TNBC and basal-like carcinomas that are associated with aggressive biological behaviour, i.e., high-grade MBCs that may have areas of squamous metaplasia and spindle cells. TCCRP is usually a TNBC with generally favourable outcome, even without administration of adjuvant systemic therapy
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